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Thyroid UK
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Levothyroxine - chest pain since increased Dose, Hashimoto

Hi Everyone

I have been very depressed and come out of the low period since increasing my dose as advised by a specialist 3 days ago.

However I am on my 3rd day of taking an increased dose of Levothyroxine from 50mg to 75mg. The first day I felt a bit sick, had tightness in my chest area, my heart was pounding a bit and slight pain in my left shoulder. Although I felt normal with energy levels (which felt great) I felt like I had drunk a very strong expresso. The tightness and asthma style breathing stayed with me all day, even when I went to bed.

Sunday I took again and again I had a tightness in the chest, which lasted from 7am to 7pm. My breathing still a bit Asthma like

Today I have taken again and the pain in the chest was a tight feeling, then pain in my left shoulder near my collar bone, and my muscle in my neck and really bad heartburn all day, and again I feel like I have had an expresso. I can still feel the tightness though not as bad now, but still lingering, and cramp under my collar bone and left bust.

I think that I have to go back down to the 50mg and see the Doctor Tomorrow to be on the safe side, as I am worried I shouldn't have another day of tight chest pain, I don't want to damage myself or my heart.

Has anyone else experienced this problem when they increased from 50 -75mg? I am not sure what to think and

maybe my dose has been increased to high too soon for my body to cope with the change?


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32 Replies

Hi ive had same since increase but also come down with cold on chest too so unsure if its related?

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Thanks, I think its best to be safe than Sorry. So did you have all the same symptoms, including the heartburn, chest tightness and shoulder cramp pains as well? If so how long did this continue for until this calmed down?

Hiya ive just been to gp today, she has diagnosed me with acid reflux and said it can be triggered by medicines etc. I said how ive got breathlessness pains in back, chest and shoulder plus got sore throat and enlarged thyroid she has booked me in for ultrasound and prescribed meds for the GERD im hoping its helps

Just out of curiosity, what meds has she prescribed?

Hypothyroidism usually causes stomach problems because of low stomach acid, not because of too miuch acid. Read what Dr Myhill has to say about hypochlorhydria (the medical name for the problem) :



The symptoms of too much acid and too little acid can cause very similar symptoms (from the point of view of the patient). Taking proton pump inhibotors (the usual prescription) to reduce stomach acid when you already have too little is a recipe for disaster in the long-term. Apart from anything else proton pump inhibitors cause dependency - the longer you spend taking them the more acid your stomach produces so you need more pills all the time.

What you need is more acid, not less, and you can buy suitable products without a prescription. Betaine hydrochloride, often with pepsin added to help break down protein, is really good and helps GERD a lot. The normal dosage size is approx 600mg per capsule. I only need to take one capsule at the start of any substantial meal.


I took Omeprazole, Lansoprazole, (both of which are PPIs) and also ranitidine, to help cut down my stomach acid, and I struggled for two years to get off them.

Adding more stomach acid has been so much more successful!

On the subject of chest pain, I got that on levo as well, and several times I thought I was having a heart attack. For me the only solution has been to take T3. No more chest pain!

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Hi Humanbean, I was given Lansoprazole 30mg for the Acid Reflux. However the Levothyroxine has lactose, which I have an intolerance too. I will question this with my Doctor. I also have to tale Vitamin D3 1000iu, to keep my levels of Vit D up.

I don't know what T3 is as a medicine.

I think I have had so many problems its hard to diagnose. I am still under investigation for possible Gall Bladder problems or possible hyenas hernia and will be seeing a specialist in the end of february. Really not looking forward to that if they say I have to have the camera down the throat….

I am glad things have worked out for you though, that must be such a relief.

I will look at the links you have provided.


Levothyroxine, known as T4, is a synthetic version of the thyroxine a healthy thyroid should produce. It is called T4 because it is Tyrosine (an amino acid) with 4 iodine atoms attached.

T4 is a storage hormone. It is inactive and is used by the body as the raw material to create T3, which is Tyrosine with 3 iodine atoms attached. T3 is an active hormone and every cell in the body needs it. If people have problems converting T4 to T3 they will feel very unwell.

People who don't convert T4 to T3 very easily can take T3 directly as a medication i.e. they take the active hormone and it makes them feel well.

T3 produced naturally in the body is known as Triiodothyronine. As a medication it is known as Liothyronine. Many people can only get well on T3 because they can't convert T4 to T3.



I take T3. Any T4-containing medication I took (levo or natural dessicated thyroid) gave me dreadful chest pain and made me feel poisoned, so I have to take thyroid hormone which has already been converted to the active form i.e. T3.

Hope that makes sense. :)

Oh thank you, that has explained it a bit clearer. I think i will be asking loads of questions on my next visit to the specialist. :-D

Did you lower the T4 when adding the T3? The Dr increased T4 and added T3 at the same time with me. Having some chest pressure in center, but no fast or hard heart beat. Don't know if I should lower T4 or not take the T3. Trying to find a different dr

It is usual practice to either keep T4 the same or lower it when adding T3, but it would depend on thyroid function test results which was most appropriate for you.

Increasing T4 and adding T3 at the same time isn't a good idea. If you don't do well on this how is anyone supposed to know which change caused the problem?

The post you answered is very old.

You would get a much better and more complete response to your questions if you wrote a brand new post, introducing yourself, and explaining your situation. If you could tell us your previous dose of meds, your current dose of meds, any test results you have, we'll try to help you if we can.

To write a new post, click on "Write A Post" in the banner of this page :


Welcome to the forum. :)

thanks for your comments Hi1234, I hope that you are given the all clear. yes I have acid reflux too. I am completely intolerant to gluten and lactose now.

You too hunny i hope you feel better soon x im cutting out gluten too but finding it difficult

Yes its hard, Tescos, sainsurys (Free From) and Planet Organic have some good things, although can be costly, Baxters do some nice soups. Its remembering all the things you can't now have. X

You could try cutting the 25mcg tablet in half and taking 62.5mcg's instead. I know 12.5mcg's sounds a silly amount to be able to take you over medicated but that's what happens to me. My heart goes haywire if I take 125mcg's but 100mcg's is to low so I take 112.5mcg's and I feel great.

Moggie x

Yes, it can be such a fine line.

Hi Moggie I may suggest this to my specialist when I see her next. Thanks for your comments. Ruth

Why dont you just try it and then tell your specialist what you have done? something along the lines of " I increased to 75mcg's as you suggested but seemed to be experiencing some sort of reaction so cut back to 62.5mcg's to see if this eased the problem". You can then go on to tell him/her if it did, or did not, ease the problem which will show him/her that you are sensible enough to take control of the situation and in turn this will give your specalist faith in your ability to read your own body and act accordingly.

Moggie x

Please check irons, folate ferritin B12 and vit D anyway (just the usual suspects for starters)

I don't have experience of Levo - just 3 years reading sufferers' experiences - especially newbies - look to testing/sorting underlying vitamins and minerals - they are most probably low, e.g low Vit D can cause chest pain (especially rib cage in a vice , hard to breathe) all very common here and should be tested by your GP. Just ask, alternatively you'll get an chest X-ray (but mine was actually low Vit D - BUT it may not be in your case). J x

What a co-incidence. I had last week increased my T3 from 50mcg to 62.5mcg and felt good with great energy for around 3 days before similar symptoms kicked in. This has also happened in the past with increases, whether it be T4 or T3. Always, the worst was at night. excruciating jaw and teeth pain and left arm and neck pain, although my heart rate was fine ( between 66 and 75) as was my BP. Also at night, at around 11pm, my temperature would plummet from 36.9 to 36.1 and I would go into a very cold clammy sweat that would soak my bed sheets. I also have severe hair loss on lower legs. Took myself off to A&E today where yet again I was given an ECG and Troponin test to check for heart attack. I was given the all clear (Yet again) but part of me thinks while I'm trying to compensate for low peripheral levels of thyroid hormone, the very low TSH level is hampering my cardiovascular system.....it's like a trade off. I sometimes think my blood calcium levels are getting too high and maybe some calcitonin could rectify it. Can't take desiccated because of the thyroid peroxidase enzyme in it. :(

Your post is interesting. How does the low TSH hamper your cardiovascular system? Also, what does the thyroid peroxidase enzyme do to you? My TSH is really suppressed and I am on Erfa NDT. Thanks


And a paragraph about NDT and it's contents

Most people on the forums who have been on synthetic T4 and then switched to desiccated thyroid report feeling better, especially if they have no thyroid gland. So it’s a popular medication, it’s just difficult to find a doctor to prescribe it. Desiccated thyroid is made from whole pig thyroids and therefore contains all the components found in a thyroid gland: T4, T3, rT3, diiodotyrosine (DIT), monoiodotyrosine (MIT), thyroglobulin, thyroperoxidase enzyme (TPO), hydrogen peroxide (H2O2), iodide, tyrosyl residues, and calcitonin (a hormone involved in calcium and bone metabolism). [7] Calcitonin is not a thyroid hormone, but another hormone produced by the parafollicular cells, which just happen to be located within the thyroid. Prescription calcitonin is administered by nasal spray or injection, because it is not absorbed well orally, so its effect in desiccated thyroid may be minimal. However, there is probably a synergy with all these additional components that make desiccated thyroid a more complete and effective replacement therapy for some than the synthetic replacements. People on desiccated thyroid tend to have healthier bones, but I believe that is from the T3, not the calcitonin.

Can be found here:http://www.tiredthyroid.com/blog/2012/03/31/desiccated-thyroid-t4-t3-t2-t1/

Hi Buggles84, well I am back on 50mg again and the symptoms are easing off. So I guess I will have to speak to my specialist in April and ask her loads of questions. I saw the Doctor and was told not to increase anything now, just wait. I also think my Levothyroxine should be changed to a Lactose free one, god knows why they have given me this one if I am Lactose intolerant. That will be another question to ask the Hospital Specialist. Thanks for your reply. x

Hi. I had similar problems when started on Levo and it was very scary. I also got more depressed and put on even more weight. Are your adrenals ok? A saliva test would tell you. I had adrenal fatigue which hampers how you use Thyroxine. Also, do you have thyroid antibodies? Are your B vits, iron and D3 ok? Don't take Levo near iron/vits etc as it can interfere with the absorption. In the end I could not get on with Levo and changed to NDT as the T3 makes a big difference to me ( I have Hashis) - but that can be a whole other can of worms trying to get the stuff prescribed.

The increases have to be very small and over a long period of time to allow your body to adjust, and you may feel worse initially when you do go up in the early days but it should settle down. You can get very good advice on this site. Maybe drop down for a day of two to let the symptoms settle and then try the increase again? See what others more experienced than I am have to tell you. Good luck

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May be introduce a 50/75 on alternate days to see how that works for you or say 75 on say Mon, Wed and Friday and 50 other days. I do this with 100/125. I find it very much trial and error. I was very surprised to find increasing by just 25 one day a week made so much difference for me.

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Bless you Tallmiss! As always there's lots of really good advice & kind support here, but as an ex A&E nurse I can't stress too highly that if you do have (as you describe it) "asthma type breathing" when you've self medicated you MUST get a professional opinion ASAP.

Your chest tightness & breathing difficulties may be due to a chest infection or you may be hyperventilating (i.e. experiencing an increased breathing & heart rate related to depression & anxiety, exacerbated by the stress of feeling so unwell on taking your Levo.). But, if you do have an expiratory wheeze (i.e. audible sounds on breathing out) there's a slim chance that you may be developing an anaphylaxis (i.e. allergic reaction) to any of the medicine's constituents for which you would want to seek appropriate medical intervention as if left unmanaged it has the potential to be life threatening.

I imagine the administrators of this Forum would always suggest we seek professional guidance. A good GP should be made aware of your responses to the increase in meds so they can provide you with appropriate medical or therapeutic support & you can make the progress to good health you deserve.

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Thank you everyone for all your replies. i went to bed last night still feeling slightly tight in the chest, pain in my left shoulder and my collar bone and I had vile coming up in my mouth. I eventually got to sleep and woke up at 4am this morning and only took my 50mg Dose, and fell back to sleep and was out cold only awaking now.

I know my specialist advised to take 100mg and 50mg on alternate days because when she rang I only had 50mg but I am so glad I didn't do that, she wanted me to increase to 75mg, I have and Its not agreed with my body, although the only positive is the depression lifted and I felt energised.

Today the pain has subsided in my chest although it feels a tad sore, its nothing like the tightness pain of yesterday, I do have Asthma as a condition and I have taken my inhalers. My appetite went completely over the last 3 days, and I would have not eaten all day, and I had to force myself to have some soup, so that appeared to be another side effect with the increased dose.

At least I feel more relaxed today, and as Eurasian-Babe advised I think I should not try to self medicate until I seek advise. The last 3 days pains in my chest area, collar bone, left shoulder socket and back shoulder blade have convinced me to stop what ever the specialist said to do and revert back to my 50mg Dose again to be safe. She said my TSH was 3.1 and needed to be lower, thats why she said to increase, but i don't really want to experience that again, especially as the pain got stronger each day. My Vitamins are ok at the moment as they were tested in A&E just over a week ago when I had my Mirena Coil removed, which they inserted whilst I had a laparoscopy, and diagnostic hysteroscopy, it was causing too much pain.

The Idea of returning to A&E alone and waiting anything upto 8 hours again is a bit daunting, but I think I will nip to the Doctors and tell them what has happened to be on the safe side, they may say I have to go into hospital to be checked anyway.

Thanks Everyone, for taking the time to reply.


I had those symptoms. After a few months I began waking in the night with heart racing, dripping in sweat gasping for breath. The symptoms would come and go. When I saw Endo he told me I was overactive and I had to come off thyroxine immediately. Endo said with Hashimos it's swings and roundabouts. Highs and lows. They get dose right feel great then you go over active have to take you off it or reduce dose, then you go underactive and have to increase dose. Have you had an ultrasound on thyroid to check for nodules? Is your GP dosing you on thyroxine or are you being looked after by Endo?

Hi Chickens12, yes looks like you are up and down too.

Yes I am being looked after by a Endo at Hospital, as my doctor noticed my levels getting lower after i was first put on 25mg of Levothyroxine and my Vitamin D shot down to just 18. (thats now ok)

I called the specialist today and spoke to her secretary and the secretary said to go back to the original 50mg dose and my symptoms will ease off in a few day. The chest pain thankfully is easing off, which is such a relief, and my appetite has returned today. I am a little low today but at least not crying so I am most likely exhausted from having my heart racing for the last 3-4 days.

I have had an Ultrasound on my Throat 6 weeks ago and checked for a Goitre and I was clear of nodules, this was checked as i am a part time singer and had to give up work as I have been too ill with tiredness and my throat has been effected and I was getting out of breath a lot.

All that was said was my TSH was 3.1 and she wanted to lower this to under 3 , to get this to about 2.5. So she decided on Friday to increase my Levothyroxine to lower my TSH. She said my pituitary gland was not working properly, she has looked at my scans. (not sure what she saw)

I guess now I have to wait until i see her in April and ask her a load of questions regarding the up and down tiredness, depression, and soreness in the throat. I need to get back to work soon, but I am no good if I am bursting into tears, and falling asleep in the day. I have had 2 investigation operations in the last 8 months.

Hopefully this will get better over the next 4 weeks as I havent been on the 50 mg Dose that long and my 2nd operation my have knocked my balances out of sink.

I have to see a Gastro Specialist soon as well, as they think I may have a gall bladder problem or a hyenas hernia. I really do not want another investigation operation, as I felt so ill after the last one 4 weeks ago, but this appears to be what happens to patients with Hashimoto, everything seems to go to pot all at once, and its just test this, test that, until everything is sorted.

Hopefully tonight I won't be laid in bed with a sore chest and arm cramps, but going by what everyone else has been saying this is a common problem, and we are kind of like guinea pigs being tested to see what works.

I am new to this condition as I was only diagnosed 8 months ago, after my stomach expanded from a size 12 to size 18 and I looked so very ill and my skin started to turn yellow, my liver was showing signs of a massive drinking problem and I have been Tee Total for 2 years. I gave up having the odd drink completely because every time I had some drink I felt ill. So in retrospect I am a lot better now. :-D

I guess I will have to prepare I may go up and down for a while.

Thank you at least I know others are up and down too, its not nice but seems a few of us are in the same boat


I shall let you know how I get on. I have been off all meds for I think 18 months now and I am with a different Endo. They think the reason I felt so awful on thyroxine previously was because I was subclinical and did not need it. My T3 and T4 were always in range it was my TSH that wasn't. Bloods next week and Endo end of Feb. I have been told I will have to go back on thyroxine.

It was a professor that quite matter of factly told me about the swings and roundabouts. He said if you don't want to go back on thyroxine we will monitor you until you can't put up with the weight gain or mood swings anymore!

The way to look at is be grateful someone is looking at you and it's all on the NHS. Lots of people have to pay privately for testing and ops.

Yes I have been Lucky Really to have my operations so quick. Oh please let me know how you do, Good Luck to you.

Well It appears now I have been to my GP and I have been advised to try again, this time I must take my Lansoprazole 30mg to stop the vile coming up (acid reflux) and alternate Levothyroxine 50/75 each day. I don't understand the logic in having a high dose one day and not the next, but it appears, she wants me to try again. Doc advised I may get some chest tightness for a while, but see if it stops after 2 weeks !. Rather strange hopefully my doctor is trying to ease me in slowly and not kill me off…Well I will see what happens tomorrow…..Hopefully I don't get chest pain like before, I don't think I could bare that again, it was bad enough for 3 days. She seems to think the acid coming up has irritated the wind pipe and that causes coughing, but pain around that area, hmm not too convinced.

Anyone else had to do this as well and told to try for 2 weeks even if you get chest pain? Seems rather odd to me.


Ruth what happened, i’m getting similar issues and struggle with a lot of acid on my tirosint.

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